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. 2021 Sep;9(18):1450.
doi: 10.21037/atm-21-3937.

Comparison of treatments for hepatocellular carcinoma patients with portal vein thrombosis: a systematic review and network meta-analysis

Jianchen Luo  1 , Liangliang Xu  2 , Lian Li  1 , Jingfu Zhang  1 , Ming Zhang  2 , Mingqing Xu  2
Affiliations

Comparison of treatments for hepatocellular carcinoma patients with portal vein thrombosis: a systematic review and network meta-analysis

Jianchen Luo et al. Ann Transl Med. 2021 Sep.

Abstract

Background: Sorafenib, hepatectomy, and transarterial chemoembolization (TACE) are the recommended treatment for portal vein tumor thrombosis (PVTT) patients. Therefore, the aim of the present study was to conduct a multi-treatment meta-analysis. The aim of the present study was to analyze the survival benefit of different treatments options on PVTT patients.

Methods: We systematically analyzed 12 randomized controlled trials (4,265 participants) from 2012 to 2019, which compared any of the following treatment options on PVTT patients: TACE, sorafenib, hepatectomy, sorafenib + TACE, hepatectomy + TACE, and sorafenib + hepatectomy. The main outcome was the 1-year survival rate of patients.

Results: The results of the rank probability of effectiveness showed that sorafenib + TACE was more likely to be the most effective treatment, sorafenib + TACE group was ranged rank 1 when compared with the others [hepatectomy group: odds ratio (OR): 0.79, 95% confidence interval (CI): 0.03-18.26; hepatectomy + TACE group: OR: 0.51, 95% CI: 0.01-13.59; sorafenib group: OR: 0.14, 95% CI 0.01-2.29, sorafenib + hepatectomy group: OR: 0.15, 95% CI: 0.00-24.88; and TACE group: OR: 0.51, 95% CI: 0.02-9.88]. The second most effect treatment option was hepatectomy alone.

Discussion: Sorafenib + TACE is more likely to be the most effective treatment option, while hepatectomy alone is the second effective treatment option.

Keywords: Bayesian framework; Hepatocellular carcinoma (HCC); portal vein tumor thrombosis (PVTT).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://dx.doi.org/10.21037/atm-21-3937). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Study selection. PVTT, portal vein tumor thrombosis.
Figure 2
Figure 2
Network structure of different treatments compared to each other. HR, hepatectomy; Sor, sorafenib; TACE, transarterial chemoembolization
Figure 3
Figure 3
Result of convergence verification. HR, hepatectomy; PSRF, potential scale reduction factor; Sor, sorafenib; TACE, transarterial chemoembolization.
Figure 4
Figure 4
ORs and 95% CIs for the effectiveness of different treatments. Results are the ORs in the column-defining treatment compared with the ORs in the row-defining treatment. For efficacy, ORs >1 favor the column-defining treatment. For acceptability, ORs <1 favor the first treatment in the order. HR, hepatectomy; Sor, sorafenib; TACE, transarterial chemoembolization; ORs, odds ratios; CIs, confidence intervals.
Figure 5
Figure 5
Rank probability of effectiveness. Rank 1 indicates most effective, rank 6 indicates least effective. HR, hepatectomy; Sor, sorafenib; TACE, transarterial chemoembolization.
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